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Midwives: Why aren’t we paying them more?

You’d never know how popular they are from their salaries


 

AOM President Katrina Kilroy with baby Vita Martel. (Marina Dempster/AOM)

“Call as soon as you’re pregnant,” is what busy midwifery clinics advice Canadian women to do, and more and more moms-to-be are running to the phone as soon as they get a positive test result. A lucky few will get on a waiting list, even fewer will get to see a midwife.

Midwives are becoming increasingly popular across the country. Their job is backed by glowing patient reviews and by a swath of independent reports that praise the nurturing, safe, and low-cost approach to birthing championed by midwifery. But while midwives are all the rage, you’d never know it from looking at their salaries.

Data provided by the Canadian Association of Midwives show the vast majority of them earn annual incomes of about $65,000, whether they are salaried public employees, like nurses, or independent professionals, like most family doctors. Even in Ontario and Alberta, the highest paying provinces, only a handful of them (barely) break the $100,000 ceiling. In comparison, the lowest-paid salaried nurse in Ontario made $78,054 in 2009.

What really riles up midwives across the country, though, is that, despite their popularity, most of them haven’t seen a pay rise in years. Joanna Nemrava, a midwife in B.C. currently involved in contract negotiations with the province, calls midwives’ compensation there (on average $60,000 a year) “reasonable,” but points to the fact that it has been frozen since 2006.

Ontario midwives are up in arms too. “We have been forced to accept contracts that were unfair,” says Katrina Kilroy, president of the Association of Ontario Midwives. AOM is currently leading a “campaign for pay equity” aimed at bringing Ontario midwives’ compensation to what it calls fair levels after “years of being neglected,” says Kilroy.

Seven years ago was the last time Ontario midwives’ salaries saw a significant one-time adjustment–and even that came after a decade-long of pay-freeze. A 2010 independent report commissioned by the Ontario Ministry of Health found that “increases for midwives fell well below those of salaried health and social assistance employees as well as public sector salaries in health and social services over the same period.” It recommended a one-time “pay-equity adjustment” of 20 per cent.

Of course, with policymakers across Canada looking for ways to constrain ballooning healthcare budgets, it may not be the best time for midwives to be asking for a salary bump. But it’s easy to make the case that midwives are well worth the extra money they’re asking for. 

Research has shown that midwives save taxpayers’ money, as they are less likely to use costly medical interventions in labour such as c-sections–one of the biggest money drains on Ontario’s hospitals, according to the Drummond Report–epidurals, episiotomies, inducing drugs, or instruments like forceps or vacuum extractors. Midwives also make a case for freeing scarce obstetricians to care for high-risk pregnancies while they handle the low-risk cases—about 80 per cent of the total. And midwifery is also a low-cost alternative in remote communities, where pregnant women have to travel long distances to give birth.

But midwives’ impact on public healthcare coffers is likely to remain marginal as long as demand for them far outstrips supply. Even in Ontario, the province with the highest number of midwives by far (the exact number is 565), four out of 10 pregnant women looking for midwifery care can’t get it. The scarcity is even greater in other provinces, some of which count fewer than a dozen midwives.

Making sure midwives are paid well would likely attract more people into the profession, saving a good amount of public money down the road.


 

Midwives: Why aren’t we paying them more?

  1. We pay for what we value.  We don’t value women having children.

    • Oh I don’t know, the obstetricians are getting paid pretty well.

      •  And midwives aren’t.

        • Yes but the problem with midwives is they are too specialized.  They only deliver babies when the circumstances are “perfect” and look after mom/babe to six weeks of age.  Obstetricians/Gynes look after women through thier whole adult life.  They deliver babies in low/high risk situations.  Family physicians look after the entire family through the whole life span AND they deliver babies.
          You can only give hospital privileges to a certain number of professionals so that they can all make a decent living so who do you pick….the ones with the most flexibility?  Let the midwives do home deliveries.

          •  Obviously you didn’t read the article, or the other posters.

          • Clearly you’re not as much of an insider as you may think since you seem to have quite a misunderstanding of the scope of practice of midwives or of how OB care is provided in much of Canada. Midwives provide care to a broad range of women and collaborate with OBs when necessary. Many women who are referred to OBs for maternity care see them throughout the pregnancy and then not afterward. 

            The Government of Ontario hired an independent third party to assess scope of practice, training, responsibilities and working conditions of midwives and to compare that to other health care professionals. Their conclusion was that it is completely appropriate to compare midwives to Family Physicians and Nurse Practitioners. In fact, they are the only relevant comparators. FPs have longer training but virtually the same scope in maternal/newborn care. FPs provide this care sometimes along with other types of care and midwives provide only maternal/newborn care but their scope is essentially the same. The conclusion of that independent 3rd  party is that midwives are significantly underpaid given their training, scope, etc and the “value” they bring to the healthcare system (their words not mine).

          • I am not debating about the value of a midwife.  I see infinite value in their services.  I am saying that in a “fee for service medical system” which much of ours is, there will always be issues with anyone making inroads in areas that will impact the money made by physicians. 

  2. They’re not paid well because they don’t have enough government lobbyists. 

    In Canada’s socialist health care system, salaries are not set by supply, demand, merit, or any other market-based value.  They are set in boardrooms in high-level negotiations between political heavyweights, lobby groups, bureaucrats, lobbyists and lawyers, that assign arbitrary payments for arbitrary health services. Welcome to socialism. Midwives need to learn to work the system.

    •  I have no idea what ‘socialist’ countries you’re always warning us about, but in social democratic countries midwives are well paid, decent daycare is available, and teachers are respected.

      Lobbying only exists in capitalist countries.

      • He’s talking about the Corporate Welfare socialist countries, which Canada has pretty much become.  You know, where we subsidize the oil industry because they have “high-level negotiations between political heavyweights, lobby groups, bureaucrats, lobbyists and lawyers”  He’s totally right, but its sort of a new definition of socialism for most of us.

        • There are no oil subsidies, that is a longstanding myth peddled by the left.

          However, we were subsidizing the province of Newfoundland with massive equalization and other payments until the oil industry completely reversed that trend.

          Not only that, rather than your mythical subsidies, the government actually penalizes the oil industry with massive taxes at the gas pump.

          • Hah!  The massive taxes are paid by me (and you, I presume) when we fill up our tanks.  The oil companies don’t pay them.

            But the oil companies get to take advantage of:
            Canadian Exploration Expense
            Canadian Development Expense
            Canadian Oil and Gas Property Expenses
            Flow-Through Shares
            CCA oil sands leases and building mines
            Accelerated Capital Cost Allowance (ACCA) for oil sands

            There’s probably more, but I’m tired.

          • Huh?  Those are not subsidies, and a couple of them have absolutely nothing to do with oil companies. This is a lot of hogwash.

            For example “CCA oil sands leases and building mines”.

            Good for you! You understand they get the oil out of the land! For that they need a lease (which is not a subsidy, ask my landlord). But they don’t mine oil. Oil is not coal.

            And yeah, companies can deduct their expenses, it’s called the Canadian taxation system.

            I’m sure you think that pretty well anything qualifies as an oil subsidy, the sun, the moon, the air we breathe…

          • Huh? Those are not subsidies, and a couple of them have absolutely nothing to do with oil companies. This is a lot of hogwash.

            For example “CCA oil sands leases and building mines”.

            Good for you! You understand they get the oil out of the land! For that they need a lease (which is not a subsidy, ask my landlord).

            And yeah, companies can deduct their expenses, it’s called the Canadian taxation system.

            I’m sure you think that pretty well anything qualifies as an oil subsidy, the sun, the moon, my dog, your cat, the air we breathe…

      • Now there’s a howler.

        •  The only ‘howler’ here is that someone your age would believe in fairytales.

    • Gee, physicians in Alberta make on average $236K a year…not too shabby AND they don’t pay the outrageous fees for insurance against lawsuits like they do in your “market-based” utopia to the south. 

      • The US health care system is not the slightest bit “market-based”.

        Anyway, I have no idea what your point is.

        • My point is that healthcare workers really aren’t that underpaid in CERTAIN provinces of Canada….and supply and demand has everything to do with the salary they are paid.  Physicians have alot of pull and midwives are going head to head with them, taking away some of their business.  That is why the government is not interested in paying them better.  There is a shortage of Family physicians in Canada…why support their competitor?

          • Supply and demand has nothing to do with physician salaries, since they themselves have no control over what they charge.
            Not only that, the government controls the number of physicians (which is the reason why there has been such a shortage, since they cut back the number of placements in the 90s) so supply is government-controlled. The only thing the government does not control is demand, and that is why we have rationing via waiting lists.

        • That is not true at all, it is nothing but market-based. It is controlled by for-profit insurance companies with rates through the roof.

          You know absolutely nothing about the US system where 50,000 people die annually from lack of adequate health care.

    • “They are set in boardrooms in high-level negotiations between political heavyweights, lobby groups, bureaucrats, lobbyists and lawyers, that assign arbitrary payments for arbitrary health services. Welcome to socialism.”

      No, that is CAPITALISM. I am an American living in Canada, and you are describing the US system, not the Canadian system.

  3. it’s not a lack on interest in the profession that creates the shortages, but the lack of hospital’s willing to increase the number of midwives with privileges that are the problem.

  4. It is a little dishonest to compare the salary of a midwife with “the lowest salaried nurse in Ontario”, given that registered nurses in Ontario are among the highest paid in the country.  Try comparing the salary of the midwives with registered nurses in Quebec or PEI or any province except Ontario, BC and Alberta and you will see that people who are making $100K are doing alright for a 4 year program of study. 
    There is great disparity between provinces in terms of pay for healthcare workers, including physicians and nurses.  A nurse making top dollar in Alberta makes over $45.00 per hour while in Quebec, the same nurse makes less than $32.00 per hour.

    • You have to compare salaries in the same province! There are other factors that effect salary, like cost of living. Also, the number they used is completely WRONG! I’m not sure where they got their numbers from, but my husband is a full-time permanent RN and he made significantly LESS then this last year. And he’s been a nurse for 6 years, so he’s not even the lowest paid! 

  5. MIdwives are probably compensated appropriately. 
    They do not have the skill level of Medical Doctors, Obstetricians or Registered Nurses.
    Their scope of practice is limited to their specialty… they monitor pregnancies and deliver babies. Complicated cases must still be supported by broader resources,
    You can’t expect to be compensated to the level of a medical professional with a broader skill set – that is not equitable.
     

    • “Probably” compensated appropriately. You’re speaking of things of which you do not know. When it comes to the health care of women and newborns, midwives have the skill level of medical doctors, obstetricians, and far and away that of registered nurses. They must be able to protect the normalcy and detect abnormalities in both home and hospital situations. The hoops they must jump through in order to do what they do are far beyond what you suspect. And like medical doctors, obstetricians and registered nurses, their hours and stress levels are far beyond anything you may ever experience.

      • Can the midwife help me with my abnormal PAP smear/biopsy/hysterectomy, refer me to an othropod when my hip needs to be replaced, scrub in to my neuro surgery, recognize leukemia, monitor me on ventilators… – no. Thus the case for the limited skill set and challenge in considering how to ‘eqate’ a midwife with MDs, RNs, Rspiratory Techs, Physiotherapists, Pharmacists, Medical Lab Technologists…. 
        Each profession carries their individual scope of practice and responsibililties towards patient care.  Each profession makes a contribution but will always rely on the support of others to deliver complete patient care. 
        There is definitely a need for midwives, they are important in making our healthcare system work better. Let’s not minimize the abiilties or contributions of other medical professionals by putting midwives on some ‘complete solution pedestal’ – all ‘unsung heroes’ that deserve the respect of out clients and our peers, and appropriate compensation based on skills and scope of respobnsibility.

        • That is why the Government of Ontario hired an independent third party to assess scope of practice, training, responsibilities and working conditions of midwives and to compare that to other health care professionals. Their conclusion was that it is completely appropriate to compare midwives to Family Physicians and Nurse Practitioners. In fact, they are the only relevant comparators. FPs have longer training but virtually the same scope in maternal/newborn care. FPs provide this care sometimes along with other types of care and midwives provide only maternal/newborn care but their scope is essentially the same (assuming that pregnant woman doesn’t need a hip replacement in labour :)). The conclusion of that independent 3rd  party is that midwives are significantly underpaid given their training, scope, etc and the “value” they bring to the healthcare system (their words not mine).

          • “FPs… virtually the same scope in maternal/newborn care”
            “FPs provide this care … with other types of care”
            “midwives provide ONLY maternal/newborn care”

            pay them for that fraction of the job

          • This makes sense if they only do that job as much as the FP. But they don’t. They do it for over 6,000 hours a year.

      • Okay, wait a minute.  While it may be true that midwives have skills that exceed most RN’s if you go to a typical labor and delivery unit at any large city hospital, you will find many nurse/midwives working on the floor….most of British descent.
        Further, it is not really honest to say that midwives have the same skill level as a doctor or obstetrician because they cannot deal with a complicated birth that requires a c-section.

        • See my response to your previous comment. Midwives compensation has been compared to FPs not OBs. No one is suggesting that midwives be paid the same as Obstetricians, or family docs for that matter. Although GPs in some rural areas may have added skills in anaesthesia, etc. for the most part the scope of practice for maternity/newborn care is very similar to midwives. The point is simply that midwives compensation has not kept pace with others working in the healthcare system and I would argue that is because governments have taken advantage of their commitment to their jobs and their relative lack of institutional power, ie, this is a pay equity issue and should be addressed as such.

          • So you would like to see the midwives making the same money per delivery as a family physician?

    • I find it interesting that you are saying that mid-wives are not as educated as Registered Nurses…hmm. To be a Registered Nurse you need a 4 year university course and complete and pass a final exam. Interesting. Since a 4 year university course is also required and passing a final exam to become a mid-wife. So, I’ll grant you that more years of university are required for doctors and by the way, obstetricians are doctors too, just not general practitioners. The obstetricians are doctors who have decided to go into that specific field, just like a brain surgeon. Same amount of education for either choice. Why you included an RN in your argument is lost on me. Obviously you don’t research very well before you decide to add your little remarks. So, based on your comment, if an RN deserves a higher pay since they are better educated, then since a mid-wife has the same amount of education, then they should also receive a higher pay than what they currently are.

  6. I’ve had two births with midwives….both times, I ended up being a bit of a complicated case that involved consulting with an OB….that said, being with a midwife enabled me to have a vaginal birth (which likely would not have happened with an OB the first time…and would have likely had the second birth be a c-section as well) and enabled me to get out of the hospital much more quickly (again, freeing up resources).  It was a wonderful system where I felt respected and where I felt safe. Midwives should definitely be paid more than nurses….they have ultimate responsibility for two lives (mom and baby) and it’s a lifestyle that requires significant personal sacrifice (i.e., on call 24/7!).  That should be paid accordingly.

  7. I work for 4 midwives. Each midwife is on call 24 hours a day for 263 days a year – they each take 102 days off a year, technically.  Mathematically, their on-call days equals 6312 hours a year – a
    person working 40 hours a week, even taking no holidays or vacations works only 2080 hours.  Midwives work all stat holidays, when they are on call they can’t leave their catchment area, they can’t enjoy a bottle of wine because they may be called at any moment, they go to movies or concerts or dinners with their pagers on and their cars fully equiped in case a client needs them, they get up in the middle of the night to go and help a new mom struggling with a fussy baby or breastfeeding etc. etc.  During their “time off” they go to conferences, do community work, recertify their skills, stay on-call for clients who really need them and sometimes they take a vacation.  And they have to run a clinic, pay utility bills, taxes, rent, buy supplies, pay for staff, accountants etc., all on a bare bones budget.  Just considering the work load and the amount of hours they put in, makes them deserving of a  much higher compensation. 

  8. Well,  asI agree wholeheartedly with the pay increase for midwives, I just think it needs to be said that women are not “unattracted” to the profession by ANY means.  There are 100 women applying to UBC every year, very qualified for the profession.  They have 10 spots available!!  Many women, myself included, apply and work for YEARS to prepare over and over again to be the BEST applicant we can be and still…other very qualified women beat us to the 10 spots.  If there were 40 spots available…wouldn’t there THEN be more midwives?  We need to also work towards that change to encourage pay increase for working midwives. There would then be far more working midwives rallying for pay increase with better results through sheer numbers!

  9. In the view of an RN I consider Midwives comparable to Nurse Practitioners. Midwifes are able to order bloodwork, diagnostic testing and even to prescribe from a predefined list of medications. RNs cannot do ANY of that without an order, although many of the skill and knowledge to do so. Do not forget that (at least in Ontario) entry to practice requires a 4-year Bachelor of Science in Nursing and Midwifes require a 4 year Bachelor of Health
    Sciences. However, much of what midwives learn during their education is more comparable in content to that of an NP… or RN(EC) as they are legally titled. This brings me to my point:wages.

    The ‘general’ starting wage for an RN in Ontario is $29-30/hr..that’s a new grad. A new NP makes in the vicinity of $40/hr (APPROXIMATELY). However, I strongly believe that NPs AND Midwives are sorely underpaid for their skills. Not only to they provide excellent service to their clients they are highly skilled and knowledgeable. I would love to become a Midwife but as this article points out I would have to take on a lot more responsibility in my career without obtaining, what I think should be, appropriate compensation.

    Lastly, childbirth is still one of the most dangerous events a woman will experience in her lifetime. That being said there is evidence that shows that outcomes for women who participate in a Midwife-supported birth have excellent outcomes (better the average woman giving birth in hospital). Midwives are valuable because they save money and lives.

    • I should also not that my wages are for nurses working in the public sector…. RNs working in privately operated nursing homes makes quite a bit less per year.

  10. I am part of a medical student initiative working to increase collaboration amongst maternal health care providers. I believe part of the problem is ignorance from the medical community to educate themselves on the scope of practice that other health care providers have. We are working to educate the future leaders of the medical community and I hope it will lead to better collegiality in the field. Best wishes. Katie from Birthing Babies Together.

  11. As someone who has gone through two pregnancies with a midwife, I don’t seem to get the feeling that the healthcare insider understands all that a midwife does for their clients.  I’ve had high blood pressure at the end of my first pregnancy plus a car accident and my baby was breach so in the end I had a csection.  Through everything my midwives were there for me (I don’t mean in a metaphorical sense but literally there!).  At wee hours in the morning when I needed to get ahold of them to answer a question of concern they would call me back at the latest 10 minutes after I paged them, what OB does that.  If there was a great concern they would meet me at the obstrics ward.  If we could of gone with our family doctor we probably would have but we live in the city and the OB you see is 99% of the time not the doctor you get on call.  With my second child I had a VBAC, I wasn’t progressing as fast as the hospital would like but with the support of my midwife I was able to have a vaginal birth.  I went through 3 doctors on call that night, the first 2 wanted to section me pretty soon after 24 hours had come and gone, the 3rd who was not from that hospital but filling in for another OB was willing to PIT me, 2 hours later I was ready to push and a healthy baby girl came soon after.  Without my midwife as my support I would have had another csection, my recovery would have been longer, and that delivery would of cost a whole lot more for the tax payers!  After getting PIT the midwife was there to take care of my child and I am now looked after by the doctor and nurses, but I will say this, the nurse was looking after me the whole time and the doctor was only there for the last two pushes.  I was very surprised how little the doctor was actually involved in the end result.  Midwives do look after low risk pregnancies but to say they specialize makes it sound like the majority of pregnancies are high risk.  Plus in many countries across the pond the only reason to have an OB vs. a midwife is because a pregnancy is high risk and more woman have midwives because it’s the norm.  I’m not looking for a debate with my comment but this is how my experience has lead me to see things.  By the way, my OB I had with my breech baby is very pro midwife and pro natural birth, after many failed attempts to turn my son I did schedule a csection with her, after that the OB sent me back to my midwife, in her view I didn’t need anything more then my midwife until the surgery.
    Midwives may not be doctors but should be paid accordingly for being there 24 hours a day for there clients!

  12. I believe that midwives should be paid the same per delivery as obstetricians. The OBs can be paid more for more complicated cases that result in necessary interventions, but reviews are absolutely required to ensure that interventions are actually necessary. I KNOW that some cesareans save lives of both mama and baby, but when the national cesarean rate is 2.5X higher than what the World Health Organization has deemed necessary, then we need to question why. Is it because obstetricians get paid more for every intervention they introduce into a labour? (It’s true – they do!!) Is it because women don’t have the support during a labour to relaize that indeed this is going to hurt and it’s a lot of work, but they can do it?? It would be so easy to say, yes, take the pain away and get an epidural. But those often result in other interventions, so is it really worth it? The pain that comes in labour is part of a hormonal cascade that is so beneficial for both Mama and baby.
    People are so quick to praise the OBs who come to save the woman with a C-section after she has endured one issue after another in a long labour… but we need to look at whether or not all the interventions could have been prevented by providing the correct support in early labour in the first place. It is proven that women who labour and deliver with midwives and doulas have births that have far ewer interventions – this SAVES money for all of us taxpayers. These women also rate their birth experiences higher than women who don’t have a supportive team working with her.
    A birth experience lasts forever. And when all members of the healthcare system work together in the mama’s and baby’s best interest, those experiences will be more positive. And THAT is better for all women and families.

  13. I just have issue with the statement “In comparison, the lowest-paid salaried nurse in Ontario made $78,054 in 2009.” Are most nurses salaried? no. Do most nurses make at least 78,054 a year? no, they make much less. Seems intentionally misleading.

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